The effect of passive muscle mobilization on the distribution of local anesthetics after supra-inguinal fascia iliaca compartment block, a pilot case study

Vermeylen, Kris; Aken, D Van; Versyck, Barbara; Roos, J. P.; Bracke, P.; Leunen, Ine; Mariano, Edward R.; Elsharkawy, Hesham

doi:10.1016/j.jclinane.2020.110100

Cited by 7 publications

(8 citation statements)

References 4 publications

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“…First, contrast agent and local anaesthetic spread may differ between cadavers and live patients both in substance viscosity and in tissue plane resistance. Furthermore, muscle contraction (in live patients) may promote increased local anaesthetic diffusion 14. Second, our results may be specific to direct anterior THA and should not be inferred to other (eg, posterior) approaches.…”

Section: Discussionmentioning

confidence: 86%

Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study

Kitcharanant

Leurcharusmee

Wangtapun

et al. 2022

Reg Anesth Pain Med

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BackgroundDuring total hip arthroplasty (THA) using the direct anterior approach, orthopaedic surgeons can identify all anatomical landmarks required for pericapsular nerve group (PENG) blocks and carry out the latter under direct vision. This cadaveric study investigated the success of surgeon-performed PENG block. Success was defined as dye staining of the articular branches of the femoral and accessory obturator nerves.Methods11 cadavers (18 hip specimens) were included in the current study. To simulate THA in live patients, an orthopaedic surgeon inserted trial prostheses using the direct anterior approach. Subsequently, a block needle was advanced until contact with the bone (between the anterior inferior iliac spine and iliopubic eminence). 20 mL of 0.1% methylene blue was injected. Cadavers were then dissected to document the presence and dye staining of the femoral, lateral femoral cutaneous, obturator and accessory obturator nerves as well as the articular branches of the femoral, obturator and accessory obturator nerves.ResultsMethylene blue stained the articular branches of the femoral nerve and the articular branches of the accessory obturator nerve (when present) in all hip specimens. Therefore, surgical PENG block achieved a 100% success rate. Dye stained the femoral and obturator nerve in one (5.6%) and two (11.1%) hip specimens, respectively. No dye staining was observed over the accessory obturator nerve in the pelvis nor the lateral femoral cutaneous nerve.ConclusionSurgeon-performed PENG block during direct anterior THA reliably targets the articular branches of the femoral and accessory obturator nerves. Future trials are required to compare surgeon-performed PENG block with anaesthesiologist-performed, ultrasound-guided PENG block, and surgeon-performed periarticular local anaesthetic infiltration.

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Section: Discussionmentioning

confidence: 86%

Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study

Kitcharanant

Leurcharusmee

Wangtapun

et al. 2022

Reg Anesth Pain Med

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“…(Helayel et al, 2006) Second, the spreading of dye in cadaver differs from living humans. Passive movement in living subjects affected the cephalad diffusion of dye (Vermeylen et al 2021). Then, the articular branches of innervation of hip joint is required to consider, especially the AON.…”

Section: Discussionmentioning

confidence: 99%

The Effect of the Minimum Effective Volume for Suprainguinal Fascia Iliaca Block in Fresh Cadavers

et al. 2022

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The goal of ultrasound-guided suprainguinal fascia iliaca block (USG-SFIB) is anesthetic spread to three nerves, which are lateral femoral cutaneous nerve (LFCN), femoral nerve (FN), and obturator nerve (ON). The 90 % minimum effective volume (MEV90) for USG-SFIB is each result of studied showed the successful block and effect in various volume for block. So, Thus, the study purposes to demonstrate the efficiency of the effective volume (MEV90,62.5 ml) for USG-SFIB and confirm the staining of dye in connective tissue of nerve (nerve layer) that focused on the obturator nerve by histological examination in cadavers. The histological result showed the dye staining on the nerve layer of the ON in epineurium (100 %) and un-staining perineurium & endoneurium. Therefore, the minimal effective volume (MEV) is effective for USG-SFIB. Moreover, dye stain at the epineurium of stained obturator nerve only.

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“…Second, the spreading of dye in cadaver differs from living humans. Vermeylen et al (2021) showed that cephalad spread of dye was affected by passive movement in living subjects. Finally, our studies focused on the common volume used in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Distribution of Various Volumes of Methylene Blue Injection in Suprainguinal Fascia Iliaca Block Under Ultrasound Guidance: A Cadaveric Study

et al. 2022

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The local anesthetic volume for a single-shot suprainguinal fascia iliaca block (SFIB) is a key factor of a block success because the courses of the three target nerves from the lumbar plexus (LP), the lateral femoral cutaneous nerve (LFCN), femoral nerve (FN), and obturator nerve (ON), at the inguinal area are isolated and within striking distance. Thus, this cadaveric study aims to demonstrate the distribution of dye staining on the LFCN, FN, ON, and LP following the ultrasound-guided SFIB using 15-50 ml of methylene blue. A total of 40 USG-SFIBs were performed on 20 fresh adult cadavers using 15, 20, 25, 30, 35, 40, 45, and 50 ml of methylene blue. After the injections, the pelvic and inguinal regions were dissected to directly visualize the dye stained on the LFCN, FN, ON, and LP. All FN and LFCN were stained heavily when the 15-50 ml of dye was injected. Higher volumes of dye (40-50 ml) spread more medially and stained on the ON and LP in 60 % of cases. To increase the possibility of dye spreading to all three target nerves and LP of the SFIB, a high volume (≥40 ml) of anesthetic is recommended. If only a blockade of the FN and LFCN is required, a low volume (15-25 ml) of anesthetic is sufficient.

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The effect of passive muscle mobilization on the distribution of local anesthetics after supra-inguinal fascia iliaca compartment block, a pilot case study

Cited by 7 publications

References 4 publications

Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study

Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study

The Effect of the Minimum Effective Volume for Suprainguinal Fascia Iliaca Block in Fresh Cadavers

Distribution of Various Volumes of Methylene Blue Injection in Suprainguinal Fascia Iliaca Block Under Ultrasound Guidance: A Cadaveric Study

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